Background: Adjuvant chemotherapy for colon cancer encompassing a fluorouracil backbone ± oxaliplatin has contributed to improved five-year disease free and overall survival.2-4 Delivery of evidence based cancer care has been a challenge for patients in rural and remote Australia.5 There is minimal data regarding adjuvant chemotherapy for colon cancer in regional and remote areas.
Aim: To examine factors influencing selection, timing of delivery and dose intensity of adjuvant chemotherapy for colon cancer in a regional Australian hospital.
Methods: Patients who received adjuvant chemotherapy for stage III colon cancer between September 2010 and June 2014 were identified using chemotherapy prescribing software. Patient demographics, comorbidities, TNM stage, and relevant chemotherapy data was collected by retrospective chart review. Patients were grouped by age (<70, ≥70) and location (<25km, 25-99km, ≥100km from treatment centre). Pearson-Χ2 and logistic regression analyses were used to examine association between demographic factors and treatment regimen, and between demographic factors and dose intensity respectively.
Results:44 patients, median age 66 (range=29-84) were included in the study. 39% of patients (n=17) resided >100km from the treatment centre and 25% (n=11) resided within 25km. Age >70 (n=18) was associated with selection of non-oxaliplatin based regimens, (p=0.001). Patients age >70 were less likely to commence adjuvant treatment within 56 days postoperatively, (p=0.073) and more likely to experience dose delay (p=0.066). Female patients were less likely to complete the target number of cycles (p=0.032).
Conclusion: Older patients were treated with oxaliplatin-based regimens significantly less frequently than younger patients. Older patients commencement of adjuvant treatment appeared to be delayed and were also more likely to experience dose delay after commencement however these trends did not reach statistical significance. Female patients were less likely to complete the target number of cycles. Demographic factors, comorbidities and chemotherapy regimen were not associated with reduction in dose intensity or completion rates.